In-silico assessment of longer measurement intervals in glycaemic control to match clinical practice

IF 4.9 2区医学 Q1 COMPUTER SCIENCE, INTERDISCIPLINARY APPLICATIONS

Computer methods and programs in biomedicine Pub Date : 2025-04-25 DOI:10.1016/j.cmpb.2025.108806

Marie Seret , Vincent Uyttendaele , J. Geoffrey Chase , Thomas Desaive

{"title":"In-silico assessment of longer measurement intervals in glycaemic control to match clinical practice","authors":"Marie Seret , Vincent Uyttendaele , J. Geoffrey Chase , Thomas Desaive","doi":"10.1016/j.cmpb.2025.108806","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and Objective</h3><div>STAR is a patient-specific glycaemic control (GC) framework accounting for both inter- and intra- patient variability to modulate insulin and nutrition in ICU patients. While providing safe, effective control to all patient, the workload induced by STAR represents a clinical burden in some ICUs. This study aims at extending the treatment interval of STAR from 1–3 hourly to 1–6 hourly to reduce the workload associated with STAR and assessing the impact on GC outcomes using virtual trials.</div></div><div><h3>Methods</h3><div>Retrospective data form 606 patients are used to create virtual patients. Insulin sensitivity is identified for each patient using a physiological model and used to build and validate the new stochastic models to provide up to 6-hourly predictions using five-fold cross-validation. Virtual trials are performed and safety, performance, nutrition intake and workload are compared and analysed.</div></div><div><h3>Results</h3><div>The extended STAR protocol 1–6 hourly measurement interval still provided high control safety and efficacy. Results showed slightly reduced %BG within the safe target band 4.4–8.0 mmol/L (from 83.8 to 81.4 %) as the measurement interval increased. It also resulted in an increased risk of hyper- (from 14.5 to 16.9 %BG > 8.0 mmol/L) and severe hypo- (from 0.03 to 0.05 %BG < 2.2 mmol/L) glycaemia. Insulin and nutrition rates decreased (from 3.5 [2.0 5.0] to 2.5 [1.7 3.0] U/h and from 100 [85 100] to 89 [71 100] % goal feed (GF) respectively). The workload was significantly reduced from 12 to 8 measurements per day.</div></div><div><h3>Conclusions</h3><div>The workload was successfully reduced by extending the measurement interval, approaching clinical practice. High performance and safety are achieved. However, the results also highlight a clear risk and reward trade-off in glycaemic control with the increased risk of hyper- and hypo- glycaemia and the reduced nutrition rates. Choosing an intermediate measurement interval could be an interesting solution. Clinical trials should be conducted to further confirm those results and consider the adoption of longer treatment intervals in STAR GC framework.</div></div>","PeriodicalId":10624,"journal":{"name":"Computer methods and programs in biomedicine","volume":"267 ","pages":"Article 108806"},"PeriodicalIF":4.9000,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Computer methods and programs in biomedicine","FirstCategoryId":"5","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0169260725002238","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"COMPUTER SCIENCE, INTERDISCIPLINARY APPLICATIONS","Score":null,"Total":0}

引用次数: 0

Abstract

Background and Objective

STAR is a patient-specific glycaemic control (GC) framework accounting for both inter- and intra- patient variability to modulate insulin and nutrition in ICU patients. While providing safe, effective control to all patient, the workload induced by STAR represents a clinical burden in some ICUs. This study aims at extending the treatment interval of STAR from 1–3 hourly to 1–6 hourly to reduce the workload associated with STAR and assessing the impact on GC outcomes using virtual trials.

Methods

Retrospective data form 606 patients are used to create virtual patients. Insulin sensitivity is identified for each patient using a physiological model and used to build and validate the new stochastic models to provide up to 6-hourly predictions using five-fold cross-validation. Virtual trials are performed and safety, performance, nutrition intake and workload are compared and analysed.

Results

The extended STAR protocol 1–6 hourly measurement interval still provided high control safety and efficacy. Results showed slightly reduced %BG within the safe target band 4.4–8.0 mmol/L (from 83.8 to 81.4 %) as the measurement interval increased. It also resulted in an increased risk of hyper- (from 14.5 to 16.9 %BG > 8.0 mmol/L) and severe hypo- (from 0.03 to 0.05 %BG < 2.2 mmol/L) glycaemia. Insulin and nutrition rates decreased (from 3.5 [2.0 5.0] to 2.5 [1.7 3.0] U/h and from 100 [85 100] to 89 [71 100] % goal feed (GF) respectively). The workload was significantly reduced from 12 to 8 measurements per day.

Conclusions

The workload was successfully reduced by extending the measurement interval, approaching clinical practice. High performance and safety are achieved. However, the results also highlight a clear risk and reward trade-off in glycaemic control with the increased risk of hyper- and hypo- glycaemia and the reduced nutrition rates. Choosing an intermediate measurement interval could be an interesting solution. Clinical trials should be conducted to further confirm those results and consider the adoption of longer treatment intervals in STAR GC framework.

查看原文本刊更多论文

更长的血糖控制测量间隔的计算机评估，以配合临床实践

背景和目的vestar是一个患者特异性血糖控制（GC）框架，考虑患者间和患者内部的可变性，以调节ICU患者的胰岛素和营养。在为所有患者提供安全、有效控制的同时，STAR带来的工作量在一些icu中成为临床负担。本研究旨在将STAR的治疗间隔从1-3小时延长到1-6小时，以减少与STAR相关的工作量，并使用虚拟试验评估对GC结果的影响。方法采用606例患者的回顾性资料创建虚拟患者。使用生理模型确定每个患者的胰岛素敏感性，并用于建立和验证新的随机模型，使用五倍交叉验证提供长达6小时的预测。进行虚拟试验，并对安全性、性能、营养摄入量和工作量进行比较和分析。结果延长STAR方案1 ~ 6 h测量间隔仍具有较高的控制安全性和有效性。结果显示，随着测量间隔的增加，在4.4-8.0 mmol/L的安全目标范围内，%BG略有下降（从83.8%降至81.4%）。它还导致高血压的风险从14.5%增加到16.9%。8.0 mmol/L)和严重的低-(从0.03到0.05% BG <；2.2 mmol/L)血糖。胰岛素和营养率分别从3.5[2.0 5.0]降至2.5 [1.7 3.0]U/h，从100[85 100]降至89[71 100]%。工作量从每天12个测量显著减少到8个测量。结论通过延长测量间隔，减少了工作量，接近临床实际。实现了高性能和安全性。然而，研究结果也强调了血糖控制中明显的风险和回报权衡，即高血糖和低血糖的风险增加和营养率降低。选择一个中间测量区间可能是一个有趣的解决方案。应进行临床试验以进一步证实这些结果，并考虑在STAR GC框架中采用更长的治疗间隔。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Computer methods and programs in biomedicine 工程技术-工程：生物医学

CiteScore

12.30

自引率

6.60%

发文量

601

审稿时长

135 days

期刊介绍： To encourage the development of formal computing methods, and their application in biomedical research and medical practice, by illustration of fundamental principles in biomedical informatics research; to stimulate basic research into application software design; to report the state of research of biomedical information processing projects; to report new computer methodologies applied in biomedical areas; the eventual distribution of demonstrable software to avoid duplication of effort; to provide a forum for discussion and improvement of existing software; to optimize contact between national organizations and regional user groups by promoting an international exchange of information on formal methods, standards and software in biomedicine. Computer Methods and Programs in Biomedicine covers computing methodology and software systems derived from computing science for implementation in all aspects of biomedical research and medical practice. It is designed to serve: biochemists; biologists; geneticists; immunologists; neuroscientists; pharmacologists; toxicologists; clinicians; epidemiologists; psychiatrists; psychologists; cardiologists; chemists; (radio)physicists; computer scientists; programmers and systems analysts; biomedical, clinical, electrical and other engineers; teachers of medical informatics and users of educational software.